Pericardial Disease & Cardiac Trauma Flashcards
What are the three most common responses to pericardial injury?
- Acute Pericarditis
- Pericardial Effusions
- Constrictive Pericarditis
A stiff, fibrous membrane that attaches to the sternum, mediastinum, and diaphragm.
-Helps maintain hearts position in the thoracic cavity
Parietal Pericardium
What is the Pericardial Sac?
-Space between layers (Visceral and Parietal Pericardium)
-Pericardial fluid lubricates the heart
Which type of Pericarditis occurs after an MI?
Dressler’s Syndrome (!!)
Delayed. Weeks to months after a myocardial event
-Often auto-immune response to damage to pericardium
What causes Acute Pericarditis?
Mostly caused by viral infection.
-Usually transient and uncomplicated
-Sometimes follows an MI
-1-3 days post transmural MI
What is Acute Benign Pericarditis?
-Acute pericarditis in absence of pericardial effusion
-Does NOT alter cardiac function
-Inflammation for unknown reason.
What are the S/Sx of Pericarditis?
Chest pain, friction rub, EKG changes
-Chest pain is acute and worsens with inspiration
-Low grade fever with sinus tachycardia
-Friction rub
How do you diagnose Pericarditis?
-Symptoms
-EKG changes in 90% of people (diffuse ST segment elevation and PR segment depression and t wave inversions)
-Caused by inflammation of superficial myocardium
What is the treatment for Acute Pericarditis?
1) Aspirin or NSAIDs!!!
-Decrease the inflammation
2) Codeine (for pain relief)
3) Colchicine
-Anti-inflammatory used for Gout
4) Steroids frequently cause relapse once discontinued, so used only if other therapy doesn’t work
What is unique about Relapsing Pericarditis?
-Can be relapsing or chronic in nature
-Relapses are rarely life threatening (usually don’t effect cardiac function)
-Two types: Incessant or Intermittent
What is Incessant Pericarditis?
Pericarditis that relapses when anti-inflammatory drugs are withdrawn (<6weeks).
-Colchicine is associated with less relapse
What is Intermittent Pericarditis?
Relapses after prolonged periods without drug treatments (>6weeks)
What is Resistant Pericarditis?
Treated with standard therapies (ASA, Prednisone)
-may respond to Immunosuppressant therapy- azathioprine (Imuran)
What is Pericarditis after Cardiac Surgery?
-Postcardiotomy syndrome presents as acute pericarditis
-The cause is infective or autoimmune
-Can occur in any patient who had pericardectomy (all CABG, valve, epicardial pacer implantation, and most congenital surgery)
-Incidence of 10-40% of cardiac surgery patients
-Less common with OHT due to immunosuppression
-More common in pediatric patients
-Treat like pericarditis (ASA or NSAIDS)
-Tamponade is possible, but rare (0.1-0.6%)
What is an effusion?
An increase in pericardial volume
How much fluid is usually contained in the Pericardial Space?
25-50 ccs